Predictive factors for in-stent late loss and non-culprit coronary lesion progression in diabetic patients undergoing drug eluting stenting

doi:10.3969/j.issn.2095-4344.2014.30.024

Abstract

Abstract:

BACKGROUND: Previous studies have suggested that the risks for coronary atherosclerotic plaque progression and in-stent restenosis are increased in patients with coronary heart disease combined with type 2 diabetes.
OBJECTIVE: To explore the predictive factors for in-stent late loss and non-culprit coronary lesion progression in patients with type 2 diabetes mellitus.
METHODS: A total of 399 stenting patients were enrolled, including 179 diabetic patients and 220 non-diabetic patients. The clinical materials, angiography parameters and biochemical markers were collected. The difference between the two groups was compared, and also we conducted subgroup analysis in the diabetic patients. Low-density lipoprotein cholesterol, hemoglobin A1c, fibrinogen and high-sensitivity C-reactive protein were detected at days 3, 120, 210 and 360 after stenting.
RESULTS AND CONCLUSION: Compared with non-diabetic patients, the stent length (P=0.18) was longer and the stent diameter (P=0.002) was smaller in the diabetic patients. The minimal lumen diameters of post-procedure and follow-up angiography in the diabetic group were significantly decreased (P=0.001, P=0), and the diabetic patients also showed severe coronary artery stenosis instantly and within the follow-up after stenting (P=0.038, P=0.004). The follow-up angiography showed that the diabetic patients had more late loss and restenosis (P=0, P=0.097). Furthermore, in the subgroup analysis of diabetic patients, the levels of hemoglobin A1c, fibrinogen and high-sensitivity C-reactive protein were significantly increased in the patients with restenosis and non-culprit lesion progression. These findings indicate that diabetic patients appear to have the higher incidence of restenosis and non-culprit lesion progression. Moreover, hemoglobin A1c, fibrinogen and high-sensitivity C-reactive protein are effective predictors for in-stent late loss and non-culprit coronary lesion progression.

中国组织工程研究杂志出版内容重点：生物材料；骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性；组织工程

全文链接：

Key words: drug-eluting stents, diabetes mellitus, coronary vessels

CLC Number:

R318

Xie Yu-xia, Shi Xue-kun, Yang Jie, Wu Gang, Cheng Lu, Qiao Rui. Predictive factors for in-stent late loss and non-culprit coronary lesion progression in diabetic patients undergoing drug eluting stenting[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(30): 4906-4910.

Figures/Tables 1

2.1 参与者数量分析按意向性分析处理，399例患者均进入结果分析。 2.2 一般资料共入选399例冠心病接受冠状动脉支架置入患者，其中糖尿病组179例，年龄(68.3±9.5)岁，男性比例63.7%；非糖尿病组220例，年龄(66.5±9.2)岁，男性比例63.2%。与非糖尿病组相比，糖尿病组既往心肌梗死的比例更高(12.3%，5.0%，P=0.009)；糖尿病组吸烟、高血压、高脂血症、肥胖(体质量指数≥24 kg/m2)等冠心病危险因素和非糖尿病组相比均未见明显差异(33.5%，41.4%，P=0.108；76.5%，77.3%，P=0.862；93.3%，90%，P=0.241；74.3%，72.3%，P=0.552)；同样，两组间用药情况，包括他汀类药物、血管紧张素转化酶抑制剂类药物、β受体阻滞剂差异无显著性意义(表1)。 2.3 冠状动脉支架置入及造影随访结果糖尿病患者和非糖尿病患者造影随访时间分别为(353.0±64.3) d和(354.0±69.1) d。糖尿病组和非糖尿病组相比，雷帕霉素洗脱支架或紫杉醇洗脱支架使用比例差异无显著性意义(P=0.769，P=0.855)。在糖尿病患者中，冠状动脉支架长度更长(P=0.018)，支架直径更小(P=0.002)。两组间支架置入前最小管腔直径和狭窄程度未见明显差异，但与非糖尿病患者相比，糖尿病患者支架置入后即刻和造影随访的最小管腔支架直径更小(P=0.001，P=0)，而且支架置入后即刻和造影随访的冠状动脉狭窄程度明显更严重(P=0.038，P=0.004)。造影随访结果提示糖尿病患者晚期管腔丢失和再狭窄发生比例明显增多(P=0，P=0.097)，见表2。 2.4 糖尿病患者实验室检查结果支架再狭窄：与无再狭窄组比较，再狭窄组基线血浆纤维蛋白原、超敏C-反应蛋白和糖化血红蛋白水平明显更高(P=0.001，P=0，P=0.015)，此趋势持续至支架置入后120 d，120 d随访期血浆纤维蛋白原、超敏C-反应蛋白和糖化血红蛋白水平也明显更高(P=0，P=0.036，P=0.026)。360 d随访期血浆纤维蛋白原、超敏C-反应蛋白和糖化血红蛋白水平也明显更高(P=0，P=0.012，P=0.003)，见表3。非靶病变进展：与非靶病变未进展组相比，非靶病变进展组基线血浆纤维蛋白原、超敏C-反应蛋白和糖化血红蛋白水平(P=0，P=0.006，P=0.003)和120 d随访期血浆纤维蛋白原、超敏C-反应蛋白和糖化血红蛋白水平(P=0，P=0.045，P=0.041)均明显更高。360 d随访期血浆纤维蛋白原、超敏C-反应蛋白和糖化血红蛋白水平也明显更高(P=0，P=0.021，P=0)，见表3。 "

References

[1] Marroquin OC,Kip KE,Kelley DE,et al.Metabolic syndrome modifies the cardiovascular risk associated with angiographic coronary artery disease in women: a report from the Women’s Ischemia Syndrome Evaluation. Circulation. 2004;109(2): 714-721.
[2] Cho EJ,Kim JH,Sutradhar S,et al. Reduction in cardiovascular risk using a proactive multifactorial intervention is consistent among patients residing in Pacific Asian and non-Pacific Asian regions: a CRUCIAL trial subanalysis. Vasc Health Risk Manag. 2014;26(10):145-156.
[3] Kang SJ,Cho YR,Park GM,et al.Predictors for functionally significant in-stent restenosis: an integrated analysis using coronary angiography, IVUS, and myocardial perfusion imaging.JACC Cardiovasc Imaging.2013;6(11):1183-1190.
[4] Lim JY,Deo SV,Kim WS,et al.Drug-eluting Stents versus Coronary Artery Bypass Grafting in Diabetic Patients with Multi-vessel Disease: A Meta-analysis. Heart Lung Circ.2014.
[5] Grundy SM,Cleeman JI,Daniels SR.Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute scientific statement.Circulation.2005;112(5):2735-2752.
[6] Morice MC,Serruys PW,Sousa JE,et al.A randomized comparison of a sirolimus-eluting stent with a standard stent for coronary revascularization.N Engl J Med. 2002;346(23): 1773-1780.
[7] 王晓东.不同种类冠状动脉支架生物相容性与置入后血管再狭窄[J].中国组织工程研究与临床康复,2009,13(9):1699-1702.
[8] 王雪芳,刘艳明.心血管支架材料生物力学及生物相容性与置入后血管再狭窄[J].中国组织工程研究与临床康复, 2010,14(34): 6409-6412.
[9] 李雪峰,徐晶,游陆,等.雷帕霉素洗脱支架和紫杉醇洗脱支架置入在冠状动脉病变治疗中的生物安全性:2年随访[J].中国组织工程研究与临床康复,2008,12(30):5807-5810.
[10] World Health Organization.Multinational Monitoring of trends and determinants in cardiovascular disease (MONICA Project) and mannual of operation. Cardiovascular Disease Unit, Geneva,1983.
[11] American Diabetes Association. Standards of medical care for patients with diabetes mellitus. Diabetes Care.1997;20(Suppl 1):5-13.
[12] Sardi GL,Loh JP,Torguson R,et al.Drug-eluting stents in patients on chronic hemodialysis: Paclitaxel-eluting stents vs. limus-eluting stents.Cardiovasc Revasc Med.2014.
[13] West NEJ,Ruygrok PN,Disco CMC, et al. Clinical and angiographic predictors of restenosis after stent deployment in diabetic patients.Circulation.2004;109(8):867-873.
[14] Ielasi A,Latib A,Colombo A.The diabetic dilemma: which drug-eluting stent works best? Minerva Cardioangiol. 2014; 62(1):39-57.
[15] Hong SJ,Kim MH,Ahn TH,et al.Multiple predictors of coronary restenosis after drug-eluting stent implantation in diabetic patients. Heart.2006;92(4):1119-1124.
[16] Moussa I,Leon MB,Baim DS.Impact of sirolimus eluting stents on outcome in diabetic patients. A SIRIUS (Sirolimus-Coated Bx Velocity Balloon-Expandable Stent in the Treatment of Patients With De Novo Coronary Artery Lesions) substudy. Circulation.2004;109(3):2273-2278.
[17] Viviani AC,Briguori C,Roncarati R,et al.Routine assessment of on-clopidogrel platelet reactivity and gene polymorphisms in predicting clinical outcome following drug-eluting stent implantation in patients with stable coronary artery disease. JACC Cardiovasc Interv.2013;6(11):1166-1175.
[18] Aloke VF,Jae SO,Michael H,et al. Predictive factors for in-stent late loss and coronary lesion progression in patients with type 2 diabetes mellitus randomized to rosiglitazone or placebo. Am Heart J.2009;157(383):e1-e8.
[19] Natarajan MK,Strauss BH,Rokoss M,et al.Randomized trial of insulin versus usual care in reducing restenosis after coronary intervention in patients with diabetes. the STent Restenosis And Metabolism (STREAM) study.Cardiovasc Revasc Med. 2012; 13(2):95-100.
[20] Siller-Matula JM,Delle-Karth G,Lang IM,et al.Phenotyping vs. genotyping for prediction of clopidogrel efficacy and safety: the PEGASUS-PCI study. Thromb Haemost. 2012;10(4): 529-42.
[21] Brener SJ,Mehran R,Dressler O,et al.Diabetes mellitus, myocardial reperfusion, and outcome in patients with acute ST-elevation myocardial infarction treated with primary angioplasty (from HORIZONS AMI). Am J Cardiol.2012; 109(8):1111-1116.